Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Fogelsville, PA | $45.18 | $2.09 – $54.47 | 6,879 | 16 |
| Dulce, NM | $141.78 | $25.20 – $207.57 | 6,880 | 6 |
| Winchester, OH | $39.89 | $29.81 – $54.49 | 6,881 | 4 |
| Pine Plains, NY | $95.18 | $86.36 – $112.80 | 6,884 | 2 |
| Schroon Lake, NY | $53.38 | $42.26 – $59.42 | 6,884 | 3 |
| North Beach, MD | $96.42 | $91.71 – $98.89 | 6,885 | 2 |
| Vestavia Hills, AL | $43.47 | $3.35 – $89.01 | 6,895 | 14 |
| Thayer, MO | $94.14 | $70.86 – $98.21 | 6,897 | 2 |
| Rock Valley, IA | $37.28 | $0.00 – $56.59 | 6,898 | 12 |
| Hasbrouck Heights, NJ | $35.39 | $19.52 – $61.75 | 6,900 | 7 |
| Heath Springs, SC | $41.64 | $41.64 – $41.64 | 6,914 | 1 |
| Mulvane, KS | $51.52 | $4.87 – $121.47 | 6,918 | 4 |
| Wellton, AZ | $0.07 | $0.07 – $0.07 | 6,935 | 1 |
| Glouster, OH | $25.61 | $0.00 – $41.89 | 6,941 | 3 |
| Corona Del Mar, CA | $43.39 | $20.61 – $48.43 | 6,947 | 4 |
| Lantana, FL | $43.29 | $0.00 – $162.41 | 6,949 | 13 |
| Amana, IA | $37.58 | $28.53 – $42.49 | 6,949 | 4 |
| Hawthorne, FL | $51.76 | $24.65 – $67.44 | 6,950 | 5 |
| Southside, AR | $24.23 | $0.00 – $30.30 | 6,951 | 7 |
| Mc Bee, SC | $118.89 | $54.22 – $193.81 | 6,952 | 4 |
| Meyersdale, PA | $6.30 | $0.00 – $57.85 | 6,963 | 7 |
| Cordova, AK | $373.12 | $27.32 – $617.03 | 6,964 | 8 |
| High Ridge, MO | $41.90 | $8.44 – $92.86 | 6,966 | 6 |
| Tomahawk, WI | $43.28 | $9.97 – $154.44 | 6,966 | 12 |
| Friendsville, MD | $65.62 | $65.62 – $65.62 | 6,967 | 1 |
| Shortsville, NY | $69.43 | $52.16 – $82.80 | 6,975 | 5 |
| Addison, NY | $93.96 | $92.37 – $99.32 | 6,975 | 2 |
| Superior, NE | $84.88 | $21.96 – $113.79 | 6,976 | 9 |
| Cloverport, KY | $29.51 | $16.20 – $29.85 | 6,982 | 2 |
| Mcconnell Afb, KS | $29.70 | $28.19 – $65.45 | 6,982 | 4 |
| Belmont, OH | $38.27 | $22.31 – $44.43 | 6,984 | 5 |
| Mineral City, OH | $58.08 | $58.08 – $58.08 | 6,990 | 1 |
| Oakland, MS | $112.97 | $29.41 – $171.02 | 6,997 | 2 |
| Coudersort, PA | $76.79 | $76.79 – $76.79 | 6,998 | 1 |
| Duxbury, MA | $58.03 | $7.86 – $78.14 | 7,000 | 14 |
| Inwood, WV | $60.23 | $3.28 – $67.93 | 7,005 | 6 |
| Middleburg, VA | $53.13 | $53.13 – $53.13 | 7,006 | 1 |
| Annville, KY | $21.50 | $0.00 – $21.57 | 7,012 | 2 |
| Craigsville, WV | $30.46 | $0.06 – $86.97 | 7,013 | 3 |
| Campbellsburg, IN | $53.44 | $53.44 – $53.44 | 7,015 | 1 |
| Pleasant View, UT | $64.14 | $30.05 – $70.57 | 7,016 | 12 |
| No. Las Vegas, NV | $47.13 | $47.13 – $47.13 | 7,019 | 1 |
| Brookline, MO | $90.14 | $36.40 – $110.39 | 7,021 | 8 |
| Castle Rock, WA | $30.51 | $0.00 – $41.99 | 7,021 | 4 |
| Bullhead, AZ | $0.02 | $0.02 – $0.02 | 7,026 | 1 |
| North Dighton, MA | $38.91 | $35.30 – $58.32 | 7,027 | 3 |
| Villisca, IA | $7.20 | $0.02 – $35.22 | 7,031 | 3 |
| Cedarburg, WI | $37.54 | $18.28 – $268.42 | 7,033 | 17 |
| North Reading, MA | $47.25 | $15.65 – $79.50 | 7,043 | 7 |
| Millersport, OH | $52.98 | $30.00 – $126.91 | 7,046 | 4 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.